CLINICAL
The injection resin technique: a novel concept
for developing esthetic restorations
Douglas A. Terry,1 John M. Powers2 and Markus B. Blatz3
1
Douglas A. Terry, DDS
Private Practice, Houston, Texas;
Adjunct Professor, Department of
Restorative Sciences, University
of Alabama at Birmingham,
Birmingham, Alabama, USA.
2
John M. Powers, PhD
Clinical Professor of Oral
Biomaterials, Department
of Restorative Dentistry and
Prosthodontics, University of Texas
Health Science Center at Houston,
School of Dentistry, Houston, Texas,
USA.
3
Markus B. Blatz, DMD, PhD
Professor and Chair, Department of
Preventive and Restorative Sciences,
University of Pennsylvania School
of Dental Medicine, Philadelphia,
Pennsylvania, USA.
Correspondence:
Dr Douglas A. Terry,
Institute of Esthetic & Restorative
Dentistry, 12050 Beamer Road,
Houston, TX 77089.
Email: dterry@dentalinstitute.com
1 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022
The concept of using an injectable molding technique to manufacture various parts has
been around for over a century.1,2 The first injection-molding machine was developed
and patented by John and Isaiah Hyatt in 1872 for producing celluloid plastic parts.1,3
The next half-century saw the adoption of this process for the manufacture of items such
as collar stays, buttons, and hair combs.3 Over the course of its development, injection
molding has been used by designers and engineers for myriad applications with a host
of materials, including glass, metals, confections, elastomers, and thermoplastic and
thermosetting polymers, to fabricate a variety of complex shapes with high dimensional
precision. It has been used in a variety of manufacturing industries, including aerospace,
automotive, jewelry, avionics, biomedical, orthodontics, pharmaceutical, scientific,
electronic, and computer technology. In dentistry, this technique has been used in the
laboratory fabrication of prosthetic appliances such as complete dentures, partial
dentures, laboratory-processed acrylic and composite provisional restorations, and
ceramic restorations. 1,2
Continued developments in adhesive technologies, the design of resin composite
formulations, and innovative application techniques have revolutionized the delivery
of minimally invasive direct resin composite restorations while improving the practice
of dentistry. In some cases, complicated layering techniques are required that are
dependent on the clinician’s skill and artistic ability. The injectable resin composite
technique provides a simplified, precise, and predictable method for developing natural
esthetic composite restorations while reducing chair time. Although not a panacea to all
restorative challenges, this technique provides the patient and clinician with an alternative
approach to various clinical situations. This technique is a unique and novel indirect/
direct process of predictably translating a diagnostic wax-up or the anatomical form of
the natural dentition of a preexisting diagnostic model into composite restorations. There
are myriad applications for this technique using a highly filled flowable (injectable) resin

1 2
Figure 1: Preoperative facial view of the maxillary anterior
segment of a 63-year-old who presented with incisal wear and
fracture on the maxillary anterior teeth. The patient requested a
conservative esthetic enhancement without orthodontic treatment.
Clinical evaluation revealed multiple diastemas and cervical
corrosion on the central incisors from lemon sucking.
3 contour,10 restorative material color and texture, lip profile,
Figure 3: A clear polyvinyl siloxane matrix was fabricated to
replicate the diagnostic wax-up.
composite, including emergency repair of fractured teeth
and restorations; modification and repair of prototypes and
provisional restorations, composite restorations (Class III,IV,
and V; veneers), and pediatric composite crowns; resurfacing
of occlusal wear on posterior composite restorations;
establishment of incisal edge length prior to esthetic crown
lengthening; orthodontic space management; development
of composite prototypes for copy milling; fabrication of an
implant-supported composite provisional restoration; and
repair of fractured or missing denture teeth.1,4-6 In addition, this
technique can be used to establish vertical dimension and
to alter occlusal schemes (anterior guidance and posterior
INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022 2
CLINICAL
Figure 2: Development of a diagnostic wax-up that established
new parameters (ie, esthetic, functional) for the final restorations.
disocclusion) prior to definitive restoration.1-3 Furthermore,
this noninvasive technique is an integral tool for enhancing
communication between the patient and the restorative team
during treatment planning.1,2,4
Developing transitional resin composite restorations using
the injectable technique is an excellent method for increasing
the patient’s understanding of the planned clinical procedure
and anticipated final result.7 Transitional composite
prototypes establish parameters for occlusal function,8 tooth
position and alignment,9 restoration shape and physiologic
phonetics, incisal edge position, and gingival orientation.
This process also eliminates confusion and misunderstanding
between the patient and the restorative team during the
treatment-planning stage.7 It can reduce the potential for
patient dissatisfaction and litigation because the process
is reversible, can be performed without preparation, and
allows the patient to accept the visual and functional result
before the definitive restorations are fabricated. In addition,
this simple procedure helps to regulate the dimensions of
the preparation design, ensures uniform spatial parameters
for the restorative material, and increases the potential for
a more conservative preparation design.4 This injectable
technique can also be used in the development and
management of soft tissue profiles and in the design of the
definitive restoration.11-14 The clinician and technician can use
this technique as a guide for developing a preapproved
functional and esthetic definitive restoration.15 In some cases,
TERRY ET AL

4 5

Figure 4: Upon completion of the adhesive protocol, the clear silicone matrix was placed over the arch and an opacious shade A2
flowable resin composite (G-aenial Universal Flo, GC America) was initially injected through a small opening above each tooth,
followed by mixing with a shade B1 flowable resin composite (inverse injection layering technique). The resin composite was cured
through the clear resin matrix for 40 seconds.

Figure 5: Completed composite veneer restorations with optimal anatomical form. The inverse injection layering technique allowed the
establishment of harmonious proportions of the transitional restorations and the surrounding biologic framework.

these transitional restorations can be worn for months or
even years during long-term interdisciplinary rehabilitation.2,4
However, this material technique should not be utilized as a
final material for full-mouth rehabilitation.
In certain clinical situations, this technique can be
performed intraorally without anesthesia. A clear polyvinyl
siloxane (PVS) impression material is used to replicate the
diagnostic wax-up or the anatomical form of the natural
dentition of a preexisting diagnostic model. The clear matrix
can be placed intraorally over the prepared or unprepared
teeth and used as a transfer vehicle for the flowable resin
composite to be injected and cured.1,2 (Figs 1 to 5)
Empirical Data
Flowable composite materials have been evaluated
in numerous studies16-40 since their inception. Although
early flowable formulations demonstrated poor clinical
performance,1,16 some of the more recent studies34,37,38
indicate that the clinical performance of specifically tested
next-generation flowable (injectable) resin composites
have similar or improved performance to specifically tested
universal resin composites. Attar and others 23 showed that
different flowable composites possessed a wide range of
mechanical and physical properties. Earlier studies by Gallo
et al. 24 on specific flowable resin composites suggested that
these materials should be limited to small-and moderate-
sized restorations having isthmus widths of one-quarter or
less of the intercuspal distance.31 However, Torres et al. 38
reported that, after 2 years of clinical service, no significant
differences were found between Class II restorations restored
with GrandioSO (VOCO) conventional nanocomposites
and those restored with GrandioSO Heavy Flow (VOCO)
flowable hybrid nanocomposites. A study by Karaman et
al. 34 showed similar clinical performance over 24 months
in restorations of noncarious cervical lesions restored with
the conventional nanocomposites (Grandio, VOCO) and
those restored with the flowable material (Grandio Flow,
VOCO). A more recent study by Sumino et al. 37 indicated
that the flowable (injectable) materials G-aenial Universal
Flo (GC America), G-aenial Flo (GC America) and
Clearfil Majesty Flo (Kuraray Noritake) had significantly
greater flexural strength and a higher elastic modulus than
the corresponding conventional nanocomposite materials,
Kalore (GC America) and Clearfil Majesty Esthetic (Kuraray
Noritake). The wear and mechanical properties of these
specific universal injectable resin composites suggested an

3 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022

TERRY ET AL
improved clinical performance compared with that of the
universal composites. Several in vitro studies conducted
at GC Research and Development comparing specific
flowable material properties of several conventional
composites found results similar to those of Sumino et al.
Of the next- generation flowable systems studied, G-aenial
Universal Flo (GC America) and Clearfil Majesty ES Flo
(Kuraray Noritake) showed superior gloss retention and
similar wear resistance to the conventional nanocomposites
tested, which included Filtek Supreme Ultra (3M ESPE),
Herculite Ultra (Kerr), Clearfil Majesty ES-2 (Kuraray
Noritake) and G-aenial Sculpt (GC America).
According to these studies, these recently developed
specific nanohybrid flowable resin (or universal injectable)
composite systems (ie, Clearfil Majesty ES Flow and
G-aenial Universal Flo) may possess properties that meet the
aforementioned mechanical, physical, and optical requisites.
These properties and the clinical behavior of the biomaterial
formulations are contingent upon their structure. New resin
filler technology allows higher filler loading because of
the surface treatment of the particles and increase in the
distribution of particle sizes. The unique resin filler matrix
allows the particles to be situated very closely to each other,
and this reduced interparticle spacing and homogeneous
dispersion of the particles in the resin matrix increases the
reinforcement and protects the matrix.41-43 In addition, the
proprietary chemical treatment of the filler particles allows
proper wettability of the filler surface by the monomer and
thus an improved dispersion and a stable and stronger bond
between the filler and resin. 8 such a correlation might 9 suggest the potential success of
Studies43-47 clearly indicate the importance that filler
content and coupling agents represent in determining
characteristics such as strength and wear resistance.
Recent studies19,31,48 report that specific flowable (universal
injectable) composites have comparable shrinkage stress to
conventional composites. According to the manufacturers,
these next-generation flowable (universal injectable)
composite formulations are purported to offer mechanical,
physical and esthetic properties similar to or better than
those of many universal composites.49 The clinical attributes
of universal flowable composites include easier insertion
and manipulation, improved adaptation to the internal
cavity wall 50, increased wear resistance, greater elasticity,
color stability, enhanced polishability and retention of
polish, and radiopacity similar to enamel. Furthermore,
the clinical indications for these next-generation flowable
resin composites are increasing as the properties of the
materials and the bond strength of adhesives to dental
4 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022
tissues improve. With improved mechanical properties
reported,37 these highly filled formulations are indicated
for use in anterior and posterior restorative applications.5
The clinical applications of these specific next-generation
universal injectable composites include sealants and
preventative resin restorations; emergency repair of
fractured teeth and restorations; fabrication, modification
and repair of composite prototypes and provisional
restorations4; anterior and posterior composite restorations;
composite tooth splinting;51 and intraoral repair of fractured
ceramic and composite restorations.51 In addition, these
composites can be used to repair denture teeth,51 establish
vertical dimension, alter occlusal schemes before definitive
restoration,5 manage spatial parameters during orthodontic
treatment, eliminate cervical sensitivity,51 resurface occlusal
wear on posterior composite restorations,51 establish incisal
edge length before esthetic crown lengthening,51 develop
composite prototypes for copy milling,5 and place pediatric
composite crowns.6
Since the past provides information to improve the future,
the lack of evidence-based research and clinical trial data
on flowable biomaterials requires clinicians to evaluate
the individual mechanical properties of these materials to
determine whether their properties are equal or superior to
those of existing materials. As the clinical performance of
these next-generation flowable materials has improved over
time, the research data have concurred. Although no direct
correlation has been found between a material’s mechanical
and physical properties and its clinical performance,
a restorative biomaterial for a specific clinical situation.16
However, clinical longevity for restorations developed with
these biomaterials remains to be determined through clinical
studies for each specific clinical application.
Future clinical applications of this novel technique with
these next-generation flowable materials may provide
clinicians and technicians with alternative approaches to
various clinical situations while allowing them to deliver
improved and predictable dental treatment to their patients.
Although the long-term benefits of this novel injectable
composite technique remain to be determined, the clinical
results achieved by the first author in the last 14 years and
the aforementioned supporting empirical data for these
next-generation nanocomposite flowables are extremely
promising. Cases 1 to 5 illustrate some of the many clinical
applications of the injectable resin composite technique
using various highly filled formulations of flowable composite
materials (Figs 6-49).
TERRY ET AL

Case 1 - Developing the Functional Composite Prototype (Figures 06-14)

12

6 7

Figure 6: Preoperative facial view of the maxillary anterior Figure 7: Development of a diagnostic wax-up that establishes
segment of a patient who presented with incisal wear and new parameters (ie, esthetic, functional) for the final restorations.
fracture on the maxillary anterior teeth.

Figure 8: Clear PVS matrix

(Memosil 2, Heraeus Kulzer)
was fabricated to replicate the
diagnostic wax-up.

Figure 9: Flowable composite

8 9
resin material (Filtek Supreme
Ultra, 3M ESPE) was injected
through a portal in the matrix,
allowing the material to
completely cover the conditioned
unprepared enamel surface.

10 11 12

Figures 10, 11, 12: Functional resin composite prototype was completed and inspected in centric relation and protrusive and lateral excursions.

13 14

Figure 13: Functional resin composite prototype established the Figure 14: Facial view at 6-year follow-up.
optimal esthetic parameters for a natural smile.

5 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022

TERRY ET AL

Case 2 - Orthodontic Space Management (Figures 15 - 22)

15 16

Figure 15, 16: Preoperative facial view prior to interdisciplinary orthodontic treatment of 11-years-old, who presented with a tooth size
discrepancy on the maxillary anterior segment and caries present on the proximal surfaces of the maxillary lateral incisors. During
orthodontic and restorative evaluation, the patient and parent were explained the significance of achieving specific space requirements
so the orthodontist could position the teeth in the most optimal restorative position that will require a minimal preparation design. It is
important that the appropriate and anticipated result be decided prior to the placement of the orthodontic appliances.

Figure 17: After review with the

patient, parent, and orthodontist, a
diagnostic wax-up was designed
to modify the size and shape of the
maxillary lateral incisors. This wax-
up allowed the restorative team to
evaluate form and function.

17

Figure 19: After the adhesive

protocol is completed, the clear
silicone matrix was placed over the
arch and shade A-1 flowable resin
composite (G-aenial Universal Flo,
GC America) was injected through
a small opening above each tooth.
The resin composite was cured
through the clear resin matrix on the
incisal, facial and lingual aspect for
40 seconds.

18 19

Figure 18: A clear PVS matrix was fabricated to replicate the

diagnostic wax-up. A small opening was made above each
tooth that was to be restored using a needled-shaped finishing
bur (ET Series bur, Brasseler USA).

6 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022

TERRY ET AL

Case 2 - Orthodontic Space Management (Figures 15 - 22) contd.

20 21

Figure 20, 21: Completed resin composite restorations with optimal anatomical form for the 11-year-old patient. The composite
injection technique allowed the establishment of harmonious proportions of the transitional restorations and the surrounding biologic
framework. Use of the technique for tooth size discrepancies in the preorthodontic treatment-planning stages simplifies technique the
understanding and management of this restorative dilemma for the patient and the interdisciplinary team.

22

Figure 22: Seven-year follow-up of composite transitional restorations after orthodontic treatment.
Note the minimal wear.

7 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022

TERRY ET AL

Case 3 - Restoring Posterior Primary Tooth with an Injectable Composite Crown (Figures 23-30)

23 24

Figure 23, 24: Preoperative occlusal view and radiograph of the primary mandibular second molar of 78-year-old patient with an
existing Class II composite restoration and caries on the distoproximal surface of the tooth. Upon initial consultation with periodontist, the
recommended treatment included an implant and bone graft, and the patient needed to temporarily discontinue his warfarin regimen.
After subsequent medical history and radiographic review and discussion with the patient and periodontist, it was decided that the
injectable resin technique would be a viable alternative treatment for this clinical situation, and the patient agreed.

Figure 26: Adhesive preparation

design included removal of
preexisting defective composite
restoration and carious dentin
and enamel; occlusal reduction
of 1.5 to 2 mm; a circumferential
chamfer 0.3 mm in depth; vertical
proximal, buccal and lingual walls
with slight convergence toward the
occlusal; all internal and external
line angles rounded and cavity
walls smoothed; and unsupported
enamel walls removed to improve
25 26 the path of material flow.

Figure 25: A clear PVS (ExaClear, GC America) matrix was

fabricated to replicate the preoperative diagnostic model, and
an opening was made above the primary mandibular second
molar with a tapered diamond bur (6847, Brasseler USA).

Figure 27: After the injection process was completed,

the matrix was removed and the excess polymerized
resin composite was scoured on the facial, lingual and
interproximal regions with a scalpel blade (#12 BD Bard-
Parker, BD Medical) and removed with a scaler. The occlusal
composite sprue was removed using an 8-fluted pyramidal-
shaped finishing bur (H274, Brasseler USA). 27

8 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022

TERRY ET AL

Case 3 - Restoring Posterior Primary Tooth with an Injectable Composite Crown (Figures 23-30) contd.

28 29

Figure 28, 29: Completed primary composite crown. The radiograph reveals ideal proximal contours and contacts with an optimal
marginal integrity at the restorative interface.

30

Figure 30: Clinical follow-up at 18 months. The patient was pleased with the results achieved using this
minimally invasive injection technique.

9 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022

TERRY ET AL

Case 4 - The Single Anterior Implant- Immediate Placement Technique (Figures 31-36)

31 32
Figure 31: Facial view of the maxillary anterior segment and Figure 32: Diagnostic wax-up was used for presurgical planning
surrounding tissue of a 28-year-old patient. of the interrelationship between the definitive restoration and the
oral structures and to fabricate the provisional restoration.

33 34

Figure 33: Prefabricated zirconia abutment was placed and
secured in position, and the access opening was sealed. Sterilized
Teflon tape was applied on the adjacent teeth to separate the
abutment, and glycerin was applied to the entire surface of the
abutment.
Figure 34: A clear silicone matrix was placed over the anterior
segment of the maxillary arch, and an opacious shade A3 flowable
resin composite (G-aenial Universal Flo, GC America) was injected
through the small opening above the abutment, followed by a
translucent A3 flowable resin composite. The resin composite mix
was cured through the clear matrix on the occlusal, buccal, and
lingual aspects for 40 seconds each using an LED curing light.

35 36

Figure 35: Biointegration of the provisional composite crown with Figure 36: Final results after placement of the implant-supported
the peri-implant architecture after 3 months. restoration, revealing optimal hard and soft tissue integration.

10 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022

TERRY ET AL

Case 5 - Restoring Anatomical Form and Color (Figures 37-49)

37 38 39

Figure 37: Preoperative facial view of the maxillary anterior segment of a 47-year-old patient who presented with cosmetic concerns
regarding his smile. The patient requested a conservative esthetic enhancement without orthodontic treatment.
Figure 38: A clear polyvinyl siloxane matrix was fabricated to replicate the diagnostic wax-up using a non-perforated tray. A small
opening was made above the lateral incisor that was to be restored using a tapered diamond bur (6847, Brasseler USA). It is important
to clean the internal surfaces with a microbrush to prevent silicone debris incorporating into the flowable material.
Figure 39: After intraenamel preparation and adhesive protocol, the clear silicone matrix was placed over the maxillary arch and an
opacious shade A1 flowable resin composite (G-aenial Universal Flo, GC America) was initially injected through a small opening above
the preparation, followed by mixing with a shade B1 flowable resin composite (injection layering technique). The resin composite was
cured through the clear resin matrix on the incisal, facial, and lingual aspects for 40 seconds, respectively.

40 41 42

Figure 40: The completed resin composite veneer with optimal anatomical form.
Figure 41: At the following appointment, the final restoration was completed by using a composite cutback technique. The artificial
enamel layer of the composite veneer was removed and a corrugated chamfer 0.3 mm in depth was placed around the entire margin
with a long, tapered diamond.
Figure 42: The entire composite surface was etched with 37.5% phosphoric acid (Gel Etchant) for 15 seconds and rinsed for 5 seconds.
Etching of the existing composite cleans the surface.

11 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022

TERRY ET AL

43 44

Figure 43: Silane was applied to the composite surface and lightly air dried. An adhesive was
applied to the composite surface and allowed to dwell for 10 seconds, air dried for 5 seconds,
and light cured for 10 seconds using an LED curing light.

45 46

Figure 44-46: Internal characterization was performed according to the appearance of the contralateral tooth and a shade-
mapping diagram. A diluted gray tint (Renamel Creative Color, Cosmedent) was placed along the incisal edge and proximal
regions with a size 08 endodontic file and light cured for 40 seconds. A diluted white tint (Renamel Creative Color, Cosmedent)
was placed along the incisal edge, proximal regions, and in the body with a size 08 endodontic file, and light cured for 40
seconds to stabilize the color and prevent mixing of the tints. A diluted yellow tint (Renamel Creative Color, Cosmedent) was
placed at the cervical and in the incisal third with a size 08 endodontic file, and light cured for 40 seconds. It is the color
variation from these modifiers and tints that creates the three-dimensional effect and the nuances within the incisal edge.

12 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022

TERRY ET AL

47 48

Figure 47, 48: A new clear silicone matrix fabricated after the connective tissue surgical procedure was placed over the anterior segment
of the maxillary arch and a clear translucent flowable resin composite (Amaris Flow HT, VOCO) was injected through a small opening
over the artificial dentin layer. The resin composite was cured through the clear resin matrix on the facial and incisal aspect for 40 seconds
each.

49

Figure 49: Three-year follow-up of the composite resin veneer with an ideal
anatomical form and color. Note the nuances in the incisal edge created by using the
composite cutback technique.

Conclusion achieved from this early concept of anatomic stratification

In the past, with the use of conventional resin composites and with successive layers of different restorative composites
the direct bonding technique, the clinician had to combine of varying refractive indexes, shades and opacities. 52-57
the hybrid and the microfill because of the inequities of This development of the polychromatic restoration from the
the materials of the time. However, polychromatism was inequities of the different composite resin systems (hybrid

13 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022

TERRY ET AL
and microfill) stimulated scientists, researchers, clinicians and
manufacturers to explore and develop restorative materials
that are not only applied in relationship to the natural tissue
anatomy, but that have similar physical, mechanical, and
optical properties to that of tooth structure.53,58 Today, these
highly filled formulations of injectable composite materials
can be used to improve adaption and color integration as
a result of internal adaptation and the mixing of colors. As
we compare the old and the new in history, only the material
of time with the proper technique can provide optimal
natural esthetic restorations. Knowledge of a concept of
the past and a desire to create are limited by the materials
clinicians have available to them for restorative procedures.
Advancements in resin composite technology continue to
improve the practice of dentistry. Continuing technological
breakthroughs allow the clinician not only to comprehend
the building blocks of the ideal composite restoration but also
to implement and maximize the potential of new materials to
attain more predictable and esthetic results.
Although new ideas and concepts continually flood the
marketplace, one should not discount the power a new
biomaterial may have on planning, design or procedure.
These developments promise to simplify the clinical
applications for esthetic and restorative techniques and
ultimately improve the level of health care provided for the
contemporary dental patient. Only the passage of time can
determine the long-term benefits of these new flowable resin
formulations.1 The clinical applications provided in this article
demonstrate the potential of these flowable nanoparticle
composite formulations to expand treatment options for a
wider range of clinical situations.
References
1. Terry DA. Restoring with Flowables. Chicago, IL; Quintessence
Publishing: 2016.
2. Terry DA, Geller W. Esthetic and Restorative Dentistry. Chicago,
IL; Quintessence Publishing: 2018.
3. Bryce DM. Plastic Injection Molding: Manufacturing Startup
and Management, vol V. Dearborn, MI: Society of Manufacturing
Engineers, 1999.
4. Terry DA. Developing a functional composite resin provisional.
Am J Esthet Dent 2012;2:56–66.
5. Terry DA, Powers JM. A predictable resin composite injection
technique, part I. Dent Today 2014;33:96,98–101.
6. Terry DA, Powers JM, Mehta D, Babu V. A predictable
resin composite injection technique, part 2. Dent Today
2014;33:80,82,84,85.
7. Terry DA, Leinfelder KF, Geller W. Provisionalization. In: Aesthetic
14 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022
and Restorative Dentistry: Material Selection and Technique. Houston:
Everest, 2009.
8. Heymann HO. The artistry of conservative esthetic dentistry. J Am
Dent Assoc 1987:14E–23E.
9. Gürel G. The Science and Art of Porcelain Laminate Veneers.
Berlin: Quintessence, 2003.
10. Baratieri LN. Esthetics: Direct Adhesive Restoration on Fractured
Anterior Teeth. São Paulo: Quintessence, 1998.
11. Donovan T, Cho G. Diagnostic provisional restorations in
restorative dentistry: The blueprint for success. J Can Dent Assoc
1999;65:272–275.
12. Preston JD. A systematic approach to the control of esthetic form.
J Prosthet Dent 1976;35:393–402.
13. Yuodelis RA, Faucher R. Provisional restorations: An integrated
approach to periodontics and restorative dentistry. Dent Clin North
Am 1980;24:285–303.
14. Saba S. Anatomically correct soft tissue profiles using fixed
detachable provisional implant restorations. J Can Dent Assoc
1997;63:767–768,770.
15. Terry DA, Geller W. Esthetic and Restorative Dentistry: Material
Selection and Technique, ed 2. Chicago: Quintessence, 2013.
16. Bayne SC, Thompson JY, Swift EJ Jr, Stamatiades P, Wilkerson
M. A characterization of first-generation flowable composites. J Am
Dent Assoc 1998;129:567-577.
17. Labella R, Lambrechts P, Van Meerbeek B, Vanherle G.
Polymerization shrinkage and elasticity of flowable composites and
filled adhesives. Dent Mater 1999;15:128-137.
18. Tabassian M, Moon PC. Filler particle characterization in
flowable and packable composites [abstract 3022]. J Dent Res
1999;79:213.
19. Baroudi K, Silikas N, Watts DC. Edge -strength of flowable
resin-composites. J Dent 2008;36:63-68.
20. Ikeda I, Otsuki M, Sadr A, Nomura T, Kishikawa R, Tagami J.
Effect of filler content of flowable composites on resin-cavity interface.
Dent Mater J 2009;28:679-685.
21. Irie M, Tjandrawinata R,Lihua E, Yamashiro T, Kazuomi S. Flexural
performance of flowable versus conventional light-cured composite
resins in a long-term in vitro study. Dent Mater J 2008;27(2):300-309.
22. Estafan AM, Estafari D. Microleakage study of flowable composite
resin systems. Compend Contin Educ Dent 2000;21:705-708.
23. Attar N, Tam LE, McComb D. Flow, strength, stiffness
and radiopacity of flowable resin composites. J Can Dent Assoc
2003;69:516-521.
24. Gallo JR, Burgess JO, Ripps AH, et al. Clinical evaluation of 2
flowable composites. Quintessence Int 2006;37:225-231.
25. Dukić W, Dukić OL, Milardović S, Vindakijević Z. Clinical
comparison of flowable composite to other fissure sealing materials: A
12 months study. Coll Antropol 2007;31:1019-1024.
26. Baroudi K, Saleh AM, Silikas N, Watts DC. Shrinkage behavior
of flowable resin-composites related to conversion and filler-fraction.
J Dent 2007;35:651-655.
TERRY ET AL
27. Celik C, Ozgünaltay G, Attar N. Clinical evaluation of
flowable resins in non-carious cervical lesions: Two-year results. Oper
Dent 2007;32:313-321.
28. Kubo S, Yokota H, Hayashi Y. Three-year clinical evaluation
of a flowable and a hybrid resin composite in non-carious cervical
lesions. J Dent 2010;38:191-200.
29. Turner EW, Shook LW, Ross JA, deRijk W, Eason BC. Clinical
evaluation of a flowable resin composite in non-carious Class V
lesions: Two-year results. J Tenn Dent Assoc 2008;88:20-24; quiz 24-
25.
30. Xavier JC, Monteiro GQ, Montes MA. Polymerization
shrinkage and flexural modulus of flowable dental composites. Mater
Res 2010;13:381-384.
31. Gallo JR, Burgess JO, Ripps AH, et al. Three-year clinical
evaluation of two flowable composites. Quintessence Int 2010;41:497-
503.
32. Yu B, Lee YK. Differences in color, translucency and
fluorescence between flowable and universal resin composites. J Dent
2008;36:840-846.
33. Clelland NL, Pagnotto MP, Kerby RE, Seghi RR. Relative
wear of flowable and highly filled composite. Journal Prosthet Dent
2005;93:153-157.
34. Karaman E, Yazici AR, Ozgunaltay G, Dayangac B. Clinical
evaluation of a nanohybrid and a flowable resin composite in non-
carious cervical lesions: 24-month results. J Adhes Dent 2012;14:485-
492.
35. Ilie N, Hickel R. Investigations on a methacrylate-based
flowable composite based on the SDR technology. Dent Mater
2011;27:348-355.
36. G-aenial Universal Flo:Editor’s Choice.Dental Advisor. 2011:19.
37. Sumino N, Tsubota K, Toshiki T, Shiratsuchi K, Miyazaki M, Latta
M. Comparison of the wear and flexural characteristics of flowable
resin composite for posterior lesions. Act Odont Scand 2013;71:820-
827.
38.Rocha Gomes Torres C, Rego HMC, Costa Perote LC, et al.
A split-mouth randomized clinical trial of conventional and heavy
flowable composites in Class II restorations. J Dent 2014;42:793-799.
39. Zaruba M, Wegehaupt FJ, Attin T. Comparison between
different flow application techniques: SDR vs flowable composite. J
Adhes Dent 2012;15:115-121.
40. Lokhande NA, Padmai AS, Rathore VP, Shingane S, Jayashanker
DN, Sharma U. Effectiveness of flowable resin composite in reducing
microleakage: An in vitro study. J Int Oral Health 2014;6:111-114.
41. Bayne SC, Taylor DF, Heymann HO. Protection hypothesis for
15 INTERNATIONAL DENTISTRY – AFRICAN EDITION VOL.12, NO.2 APRIL/MAY 2022
composite wear. Dent Mater 1992;8:305-309.
42. Turssi CP, Ferracane JL, Vogel K. Filler features and their effects on
wear and degree of conversion of particulate dental resin composites.
Biomaterials 2005;26:4932-4937.
43. Lim BS, Ferracane JL, Condon JR, Adey JD. Effect of filler fraction
and filler surface treatment on wear of microfilled composites. Dent
Mater 2002;18:1-11.
44. Venhoven BMA, de Gee AJ, Werner A, Davidson CL. Influence
of filler parameters on the mechanical coherence of dental restorative
resin composites. Biomaterials 1996;17:735-740.
45. Condon JR, Ferracane JL. In vitro wear of composite with varied
cure, filler level, and filler treatment. J Dent Res 1997;76:1405-1411.
46. Condon JR, Ferracane JL. Factors effecting dental composite
wear in vitro. J Biomed Mater Res 1997;38:303-313.
47. Beatty MW, Swartz ML, Moore BK, Phillips RW, Roberts TA.
Effect of microfiller fraction and silane treatment on resin composite
properties. J Biomed Mater Res 1998;40:12-23.
48. Cadenaro M, Marchesi G, Antoniolli F, Davidson C, De
Stefano Dorigo E, Breschi L. Flowability of composites is no guarantee
for contraction stress reduction. Dent Mater 2009;25:649-654.
49. Yamase M, Maseki T, Nitta T, et al. Mechanical properties of
various latest resin composite restoratives [abstract 464]. J Dent Res
2010; 89(special issue A).
50. Yahagi C, Takagaki T, Sadr A, Ikeda M, Nikaido T, Tagami J.
Effect of lining with a flowable composite on internal adaptation of
direct composite restorations using all-in-one adhesive systems. Dent
Mater J. 2012;31:481-488.
51. Terry, DA. What other restorative material has so many uses:
Flowables: Int Dent (Africa Ed) 2012;3:42-58.
52. Terry DA. Natural aesthetics with composite resin. Mahwah, NJ;
Montage Media Corporation: 2004.
53. Terry DA. Restoring the incisal edge. N Y State Dent J
2005;71:30-35.
54. Terry DA, McLaren EA. Stratification: Ancient art form applied to
restorative dentistry. Dent Today 2001;20:66-71.
55. Terry DA. Dimension of color: Creating high-diffusion layer with
composite resin. 2003;24(suppl 2):3-13.
56. Terry DA. Developing natural aesthetics with direct composite
restorations. Pract Proced Aesthet Dent 2004;16:45-52, quiz 54.
57. Dietschi D. Free-hand composite resin restorations: A key to
anterior aesthetics. Pract Periodont Aesthet Dent 1995;7:15-25.
58. Rinn LA. The Polychromatic Layering Technique: A practical
manual for ceramics and acrylic resins. Carol Stream, IL:
Quintessence,1990:11-30.
Reprinted with permission by QDT, Quintessence Publishing:
Terry DA, Powers JM, Blatz MB. The Injection Resin Technique:
A Novel Concept for Developing Esthetic Restorations. QDT
2020:3-17